Impact of the COVID-19 pandemic on the self-care and health condition of the older adults. CUIDAMOS+75. A mixed methods study protocol.

Aims: To assess the impact of the COVID-19 pandemic on the health condition of people ≥75 years of age and on their family caregivers in Spain. Design: Multicentric, mixed method concurrent study. Methods: This work, which will be conducted within the primary care setting in 11 administrative regions of Spain, will include three coordinated studies with different methodologies. The first is a population-based cohort study that will use real-life data to analyze the rates and evolution of health needs, care provision, and services utilization before, during, and after the pandemic. The second is a prospective cohort study with 18 months of follow-up that will evaluate the impact of COVID-19 disease on mortality, frailty, functional and cognitive capacity, and quality of life of the participants. Finally, the third will be a qualitative study with a critical social approach to understand and interpret the social, political, and economic dimensions associated with the use of health services during the pandemic. We have followed the SPIRIT Checklist to address trial protocol and related documents. This research is being funded by the Instituto de Salud Carlos III since 2021 and was approved by its ethics committee (June 2022). Discussion: The study findings will reveal the long-term impact of the COVID-19 pandemic on the older adults and their caregivers. This information will serve policymakers to adapt health policies to the needs of this population in situations of maximum stress, such as that produced by the COVID-19 pandemic. Trial Registration: Identifier: NCT05249868 [ClinicalTrials.gov].

[Monitoring of heparinization in cardiac surgery with ACT: accreditation of the point-of-care test in the Bordeaux University Hospital Centre]. / Surveillance de l'héparinisation en chirurgie cardiaque par l'ACT : accréditation de l'analyse en biologie délocalisée au CHU de Bordeaux.

ACT (Activated Clotting Time) is a point of care test (POCT) on whole blood, used to monitor the heparinization of patients in the operating room in cardiac surgery (ExtraCorporeal Circulation ECC) and in interventional cardiology (TAVI, AF ablation). The ACT is concerned both by the ISO 22 870 standard and French regulations regarding POCT. We performed an important work at the Bordeaux CHU on its accreditation, by rationalizing and making the park uniform (11 HemochronTM Signature Elite), standardizing the training and the habilitation of operators in medical units, introducing periodic quality controls, centralizing in the laboratory the management of the devices and reagents and by connecting it to the laboratory's computer system (Middleware, SIL et expert softwares). One year after, we have some positive feedbacks with only a few technical problems and with only few remarks raised during internal audits.

Hotel housekeepers and occupational health: experiences and perceived risks.

Background: Hotel housekeepers are one of the most important occupational group within tourism hotel sector; various health problems related to their job have been described, above all musculoskeletal disorders. The objective of this study is to understand the experiences and perceptions of hotel housekeepers and key informants from the Balearic Islands (Spain) regarding occupational health conditions and the strategies employed to mitigate them. Methods: A qualitative study was carried out. Six focus groups with hotel housekeepers and 10 semi-structured interviews with key informants were conducted. Next, we carried out a content analysis. Results: Hotel housekeepers reported musculoskeletal disorders, anxiety and stress as main occupational health problems; health professionals underscored the physical problems. Hotel housekeepers perceived that their work (physically demanding and with repetitive movements) caused their health conditions. To solve health issues, they used medication (anti-inflammatory agents, painkillers, sedatives and anxiolytics), which allowed them to continue working; health public services, generally rated as satisfactory; individual protective equipment; ergonomics (with difficulties due to high work pace and hotel facilities) and physical activity. Two contrasting attitudes were identified regarding sick leave: HHs who refused to accept a doctor-prescribed sick leave (due to fear of being fired, sense of responsibility, ...), and those who accepted it (because they could not continue working, they prioritised health before work). Conclusions: Our results might contribute to plan improvement strategies and programs to address health problems among hotel housekeepers. These programs should include interventions, such as coping strategies for the work-related risk factors (i.e., stress) and strategies to reduce medicine consumption. Additionally, hotel facilities should adopt policies focused on making workplaces more ergonomic (i.e., furniture) and to diminish the work pace.

Development and Evaluation of a Digital Health Intervention to Prevent Type 2 Diabetes in Primary Care: The PREDIABETEXT Study Protocol for a Randomised Clinical Trial.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a highly prevalent disease associated with an increased risk of comorbidities, premature death, and health costs. Prediabetes is a stage of glucose alteration previous to T2DM, that can be reversed. The aim of the study is to develop and evaluate a low-intensity, multifaceted, digital intervention to prevent T2DM. The intervention comprises: (1) the use of mobile health technology to send tailored text messages promoting lifestyle changes to people at risk of T2DM and (2) the provision of online education to primary healthcare physicians and nurses about management of prediabetes. METHODS: In stages 1-4 we will design, develop and pilot-test the intervention. In Stage 5 we will conduct a phase II, six-month, three-arm, cluster randomized, clinical trial with 42 primary care professionals and 420 patients at risk of T2DM. Patients will be allocated to a control group (usual care), intervention A (patient messaging intervention), or intervention B (patient messaging intervention plus online education to their primary healthcare professionals). The primary outcome will be glycated haemoglobin. All the procedures obtained ethical approval in June 2021 (CEI-IB Ref No: IB4495/21PI). DISCUSSION: Digital health interventions can effectively prevent T2DM and reduce important T2DM risk factors such as overweight or hypertension. In Spain, this type of intervention is understudied. Moreover, there is controversy regarding the type of digital health interventions that are more effective. Findings from this study may contribute to address T2DM prevention, through a low-cost and easily implementable intervention.

Anxiety, Depression, and Concern About Employment Status of Hotel Housekeepers in the Balearic Islands During the COVID-19 Pandemic: A Longitudinal Study.

Tourism is a crucial economic sector in the Balearic Islands (Spain). COVID-19 pandemic might severely impact hotel housekeepers (HHs) due to their already precarious employment situation. The purpose is to assess the evolution of the concern about employment status, anxiety, and depression of HHs. This is a longitudinal study conducted with a subset of participants from a primary care, health promotion intervention study. Two additional visits were added (March-April and October-December 2020) for the purpose of this study. We recruited 290 HHs in March-April 2020; 237 were again interviewed during October-December 2020. In the first visit, high level of concern about employment was associated with age under 50, temporary contracts and external locus of control (LOC). Moderate-severe anxiety was associated with low social support and external LOC; moderate-severe depression was associated with low social support. Regarding the second visit, age, years working as HH, type of contract, social support, and LOC were not associated with concern about employment status, anxiety, and depression. There was a larger proportion of HHs with moderate-severe anxiety and depression among HHs with high degree of concern. Concern increased significantly among HHs: over 50 years of age; with more than 15 years in the job, a recurring seasonal contract and normal social support. After adjusting by age, type of contract, LOC, and social support, we found a statistically significant increase (12.0%) of HHs highly concerned about their job situation: compared to the first visit, HHs were 2.3 more likely to have a high degree of concern in December 2020. In contrast, increases in moderate-severe anxiety (0.3%) and depression (4.3%) between the two periods were not significant. In HHs, the COVID-19 pandemic has caused significant concern about employment status and symptoms of depression and anxiety. In the uncertain times of the pandemic, mental wellbeing benefits from variables that confer stability, such as internal LOC, perception of social support, and a stable job. Longitudinal results point at long lasting effects of the COVID-19 pandemic on mental health. It is crucial to allocate additional resources in primary care to adequately address the anticipated influx of needs.

Assessing the feasibility and acceptability of a cluster-randomized study of cognitive behavioral therapy for chronic insomnia in a primary care setting.

BACKGROUND: Cognitive behavioral therapy for chronic insomnia (CBT-i) is the treatment of choice for this condition but is underutilized in patients who attend primary care. The purpose of the present feasibility-pilot study was to assess the feasibility and acceptability of a cluster-randomized study of CBT-i in a primary care setting. METHODS: This study, performed at two primary health care centers in Majorca, Spain, was a mixed methods feasibility-pilot study of a parallel cluster-randomized design comparing CBT-i and usual care (UC). Patients were included if they were 18 to 65 years-old; had diagnoses of chronic insomnia according to the Insomnia Severity Index (ISI ≥ 8); had insomnia for more than 3 months. Twenty-five GPs and nurses and 32 patients were randomly allocated to two groups. The main outcome of the intervention was improvement of dimensions of sleep quality, measured using the Spanish version of the Pittsburgh Sleep Quality Index, at baseline and at 3 months after the intervention. Other primary outcomes of the study were the feasibility and applicability of the intervention, collected through nominal groups. A thematic analysis was performed to classify primary care provider (PCP) proposals. Additionally, we assessed the recruitment process, compliance with the intervention sessions, and patient retention. RESULTS: We adapted the CBT-i approach of Morin to a primary care context. After intervention training, PCPs expressed the need for more extensive training in the different aspects of the therapy and the discussion of more cases. PCPs considered the intervention as adequate but wanted fewer but longer sessions as well as to discard the cognitive restructuring component. PCPs considered it crucial to prepare each session in advance and to establish a specific agenda for the CBT-i. Regular reminders given to PCPs and patients were suggested to improve study participation. Compared to the UC group, higher proportions of patients in the intervention group had short sleep latency, slept for longer than 5 h, and had fewer sleep disruptions. CONCLUSIONS: This feasibility-pilot study identified several key issues that must be addressed before performing a CBT-i intervention in future clinical trial in a primary care setting. TRIAL REGISTRATION: NCT04565223 . (Clinical trials.gov) Registered 1 September 2020-Retrospectively registered.

Multicenter randomized controlled trial comparing the effectiveness and safety of hydrocellular and hydrocolloid dressings for treatment of category II pressure ulcers in patients at primary and long-term care institutions.

BACKGROUND: Pressure ulcers are a major burden to patients because they affect health, well-being, and health-related quality of life. Thus, prevention and early treatment of pressure ulcers is a major challenge for health care professionals. OBJECTIVE: To compare the efficacy of hydrocellular and hydrocolloid dressings after 8 weeks of treatment of category II pressure ulcers. DESIGN: A prospective multicenter clinical trial with blinded outcome assessors. PARTICIPANTS AND SETTINGS: Adult patients with category II pressure ulcers from primary and long-term care institutions on Majorca island. METHODS: Category II ulcers were treated with ALLEVYN Adhesive® dressings or VARIHESIVE® GEL CONTROL dressings, with the primary outcome being healing of the ulcers in 8 weeks. Blinded confirmation of ulcer healing was performed by a treatment-group assessment committee. Estimates of cumulative survival probabilities were determined using the Kaplan-Meier method and analyses of effectiveness were performed using the chi-squared test. RESULTS: A total of 169 patients with pressure ulcers were enrolled, 84 of whom received hydrocellular dressings and 85 of whom received hydrocolloid dressings. A total of 58% were women and 56% were from primary care institutions. The hydrocellular dressing group had a higher percentage of healed pressure ulcers at 8 weeks (90.7% vs. 77.1%, p = 0.039) and a shorter average healing time (3 weeks vs. 4 weeks, p = 0.015). Analysis of safety outcomes at 8 weeks indicated that the hydrocellular dressing group had a smaller proportion of ulcers that were unhealed (3.9% vs. 7.1%) and a smaller proportion of ulcers that progressed to a higher category or infection (5.3% vs. 15.7%), although these differences were not statistically significant. CONCLUSIONS: This study of patients with category II pressure ulcers indicated that hydrocellular dressings were superior to hydrocolloid dressings in terms of healing at 8 weeks and time required for healing, although these two dressings had similar safety profiles.

Knowledge and attitudes of primary care nurses about the management of patients with insomnia. / Conocimientos y actitudes de las enfermeras de Atención Primaria sobre el manejo del paciente con insomnio.

OBJECTIVE: To describe the knowledge, attitudes, and performance of primary care nurses in the management of patients with insomnia. METHODS: Descriptive study. An online questionnaire was sent to all primary care nurses of the Majorca Primary Care Department between June-July 2014. MEASUREMENTS: sociodemographic variables, professional characteristics, tuition, usual clinical practice in the management of patients with insomnia. RESULTS: 138 nurses answered the questionnaire (47%). Most of them were women (92.8%), 50.42 years old (DE=8.9). The majority considered insomnia an important health problem. Only 11% had received some formative activity on insomnia in the last 5 years. Nearly half declares to ask patients about consequences of insomnia in their jobs and about habits that alter their sleep quality. 79.7% considered the possible adverse effects of insomnia drugs and take into consideration the age of patient (80.4%). The usual treatments were sleep hygiene (76%), phytotherapy (44.9%) and 22.4% cognitive behavioral therapy (CBT). This therapy is considered effective and applicable by nurses (63.7%) and doctors (58%). Those nurses who attended courses in the last 5 years apply CBT more frequently. CONCLUSIONS: Nurses conduct a correct anamnesis and evaluation of patients with insomnia. However some therapies of known effectiveness, such as CBT, are still scarcely applied.

First Detection of Interstellar S2H.

We present the first detection of gas phase S2H in the Horsehead, a moderately UV-irradiated nebula. This confirms the presence of doubly sulfuretted species in the interstellar medium and opens a new challenge for sulfur chemistry. The observed S2H abundance is ~5×10-11, only a factor 4-6 lower than that of the widespread H2S molecule. H2S and S2H are efficiently formed on the UV-irradiated icy grain mantles. We performed ice irradiation experiments to determine the H2S and S2H photodesorption yields. The obtained values are ~1.2×10-3 and <1×10-5 molecules per incident photon for H2S and S2H, respectively. Our upper limit to the S2H photodesorption yield suggests that photo-desorption is not a competitive mechanism to release the S2H molecules to the gas phase. Other desorption mechanisms such as chemical desorption, cosmic-ray desorption and grain shattering can increase the gaseous S2H abundance to some extent. Alternatively, S2H can be formed via gas phase reactions involving gaseous H2S and the abundant ions S+ and SH+. The detection of S2H in this nebula could be therefore the result of the coexistence of an active grain surface chemistry and gaseous photo-chemistry.

[Dietary habits and physical activity in a secondary school in the Balearic islands]. / Habitos de alimentación y actividad física en un instituto de Educación Secundaria secundaria de Baleares.

OBJECTIVE: To evaluate the changes in dietary habits and physical activity, as well as the prevalence of obesity and overweight that have occurred in a cohort of 1st and 4th year secondary school pupils after non-structured health education activities. METHOD: A descriptive, longitudinal study, in which anthropometric variables, dietary habits, leisure and physical activity were collected in the 1st year secondary school pupils (n=61), and they were measured again when they were in the 4th year. The differences between the two school years were analysed using the Mc Nemar-Bowker Test. During the period of the study educational sessions were given on healthy eating and physical activity. RESULTS: The prevalence of overweight decreased significantly (from 14.8% to 3.7%) and the level of physical activity has increased. No statistical differences were detected in the quality of breakfast or in the quality of the Mediterranean diet. CONCLUSIONS: Some of the aspects studied have improved without being able to attribute this improvement to the educational sessions given. To determine and analyse the healthy living habits of adolescents would enable us to plan realistic interventions, adapted to the particular environment. They should be structured and continuous over time and approach areas of knowledge, skills and emotions, and directed, not only at the young people, but also their families, the internal environment of the educational centre. There should be coordination of community resources in order to make a coordinated approach.

[To establish nurse research priorities in Spain: Delphi study]. / Establecimiento de prioridades de investigación en enfermería en España: estudio Delphi.

OBJECTIVE: To identify nursing research priorities in Spain as suggested by nurses and service users. METHOD: A Modified Delphi technique was used. The first round started off with a 24-item document for which consensus had been previously achieved. Experts participating in this modified (two rounds) Delphi technique were: nursing managers (community and hospital care settings), nursing school directors, scientific nursing association representatives, nursing researchers attending the National Nursing Research Conference, and service users. RESULTS: Main priorities identified for nursing research were: 1) evaluating the effectiveness of nursing interventions, 2) identifying strategies for health promotion empowering service users, 3) developing evidence-based care through implementing and evaluating results, and 4) evaluating the quality of nursing care. CONCLUSIONS: Results may help research managers and administrators identify and develop nursing research promotion strategies as well as more strongly sustained funding policies and decisions.

[Needs of the family caregivers of stroke survivors in the home: structured review of the literature from 2000 to 2007]. / Necesidades de las cuidadoras familiares de personas con accidente cerebrovascular en el domicilio: revisión estructurada 2000-2007.

OBJECTIVE: To perform a structured review of the literature from 2000 to 2007 on the needs of the caregivers of stroke survivors in the postacute phase of the illness process at home. METHODS: Searches were conducted in the CINAHL, MEDLINE, EMBASE, PSYCHINFO, Cochrane Library Plus, CDSR (coch), DARE, CCTR, ACP Journal Club (ACP), IBECS, LILACS and IME databases using the terms "stroke", "caregiver" and "needs (assessment)". RESULTS: We selected 270 abstracts for review. Of these, only 53 met the inclusion criteria and just 12 achieved preestablished quality standards. Despite wide variability among the selected studies, the literature reviewed revealed that the two most prevalent needs for the caregivers of stroke survivors were information and support in the development of caregiving skills. Care for the caregiver herself, as well as the development and provision of support services, were defined as the two main areas where these participants seem to need support while adapting to and performing this newly adopted role. CONCLUSIONS: The studies reviewed show an increasing demand for support and care for stroke survivors' caregivers. Because of the highly diverse contexts of these studies, the lack of an explicit definition on the concept of "need", and the wide heterogeneity in caregivers' situations, summarizing the results of these studies is difficult. New studies are required in our context that take these limitations into account and try to overcome them.

[Situation analysis and proposals for improving primary care nursing in Mallorca: study with focal groups]. / Análisis de situación y propuestas de mejora en enfermería de atención primaria de Mallorca: un estudio con grupos focales.

BACKGROUND: The primary care reform (PCR) has give rise to some major changes in the nursing profession. The objectives of this study are to analyze the achievements made by the nurses, to identify the problems they currently have in primary care and to suggest some lines along which work can be done for the future. METHOD: Qualitative research (focal group method). Eight groups were made segmented by occupational category and the position held. Scope of the analysis: the role of nurses, services supply and organization, participation and management, marketing and training. RESULTS: In the opinion of those surveyed, the PCR has entailed a broadening of the nurses' skills, although their role is still well-defined. The nurses are of the opinion that there is no listing of services inherent to nursing despite the leading role they obviously play in home care and health education. The need has been identified of assess the existing health programs in terms of results. Concerning to health services organization, main problems were related to the lack of adapting staffing in keeping with the rise in population and difficulties of internal communications within the health professional teams and the very small degree to which nursing services are disseminated. The need is felt of broadening pre-diploma training with regard to some subjects (health education) and skills (teamwork). CONCLUSIONS: Although the PCR has meant improvements for the nurses, solutions have as yet to have been provided to some aspects (including defining a listing of services, adapting staffing, internal communications, marketing, training) and given the opportunity the transferring of authorities over health care entail, further progress must be made toward innovative proposals to improve the health services.